Provider Demographics
NPI:1609887728
Name:CONNOLLY, ROBERT PATRICK (DPT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:PATRICK
Last Name:CONNOLLY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8005 HARFORD RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-5701
Mailing Address - Country:US
Mailing Address - Phone:410-663-3133
Mailing Address - Fax:410-663-3089
Practice Address - Street 1:8005 HARFORD RD
Practice Address - Street 2:SUITE 102
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-5701
Practice Address - Country:US
Practice Address - Phone:410-663-3133
Practice Address - Fax:410-663-3089
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21572225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD213LMedicare PIN